Diagnostic Accuracy in Assessment of Depth of Myometrial Invasion in Low-grade Endometrioid Carcinoma: A 2 Center Comparative Study by MRI and Intraoperative Assessment
| Autor: | W. Glenn McCluggage, Hans Nagar, Mamta Gupta, Rebecca Nagar, Toni Peters |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Pathology medicine.medical_treatment Diagnostic accuracy Likelihood ratios in diagnostic testing Pathology and Forensic Medicine Stage ib Predictive Value of Tests Carcinoma Medicine Humans Retrospective Studies medicine.diagnostic_test business.industry Obstetrics and Gynecology Magnetic resonance imaging medicine.disease Magnetic Resonance Imaging Confidence interval Endometrial Neoplasms Myometrium Lymph Node Excision Lymphadenectomy Female Radiology Endometrioid Carcinomas business Carcinoma Endometrioid |
| Zdroj: | International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists. 40(5) |
| ISSN: | 1538-7151 |
| Popis: | The role of lymphadenectomy in endometrial carcinomas is controversial, especially in low-grade endometrioid carcinomas. In many institutions, lymphadenectomy in the latter neoplasms is undertaken only when there is deep myometrial invasion, defined as invasion involving 50% or more of the myometrium (FIGO stage IB). There has been considerable debate as to the best modality to detect deep myometrial invasion. In Europe, preoperative magnetic resonance imaging (MRI) is the most commonly used modality while in North America, intraoperative assessment (IOA) is undertaken in most, but not all, institutions. The aim of this study was to compare the diagnostic accuracy of these 2 modalities in identifying deep myometrial invasion in low-grade endometrioid carcinomas. Two patient cohorts were studied from Belfast, UK (n=253) and Boston, USA (n=276). With respect to detecting deep myometrial invasion, MRI had a sensitivity of 72.84%, positive predictive value of 75.64% and a positive likelihood ratio of 6.59 (95% confidence interval; 4.23-10.28). IOA had a sensitivity of 78.26%, positive predictive value of 80% and a positive likelihood ratio of 20.00 (95% confidence interval; 10.35-38.63). The superior positive likelihood ratio suggests that IOA is better than MRI in determining deep myometrial invasion and the nonoverlapping 95% confidence intervals suggest this is a significant finding. However, there are significant resource implications associated with IOA and preoperative MRI carries other advantages that are discussed herein. |
| Databáze: | OpenAIRE |
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